Radar on Medicare Advantage
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CMS Spooks MA Plans With Warning About Secret Shopping, Enhanced Monitoring
If Medicare Advantage organizations and Prescription Drug Plans (PDPs) this open enrollment season have the haunting feeling they’re being watched, it’s because they are. After implementing new rules aimed at better protecting beneficiaries from confusing and misleading Medicare marketing, CMS in October issued two memos informing plans that they’ve done some digging into recent marketing activities and they don’t like what they’ve seen so far.
CMS has reported that marketing-related complaints more than doubled between 2020 and 2021 — which it largely attributed to the actions of third-party marketing organizations (TPMOs) — and has expressed particular concern with third-party marketers’ claims that some benefits are widely available to seniors when they vary by service area. To address these concerns, CMS made key changes this year, such as requiring TPMOs to use a standardized disclaimer that they do not offer every plan available in the area, clarifying that independent agents and brokers qualify as TPMOs, and stipulating that plans in their contracts with TPMOs require full recordings of sales calls with beneficiaries.
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Insurers Eye Growing D-SNP Market, Show Modest Interest in I-SNPs
As Medicare Advantage organizations market a host of new products and benefits for the 2023 plan year, large and regional insurers alike are boosting their Dual Eligible Special Needs Plan (D-SNPs) presence. And while those plans continue be the most popular type of SNP — especially as CMS phases out so-called D-SNP look-alikes and pushes states to further integrate Medicare and Medicaid programs — a smaller but growing group remains interested in pursuing the more specialized Chronic Condition SNP (C-SNP) and Institutional SNP (I-SNP) markets.
According to an analysis of CMS’s Landscape Files from Clear View Solutions, LLC, there will be 1,320 SNPs on the market in 2023, compared with nearly 1,192 in 2022 and 1,019 in 2021. Drilling down further, Clear View observes that there will be 1,068 SNPs available next year that were offered in 2022, compared with 926 plans that carried over from 2021 to 2022. The total number of D-SNPs, which serve members who are dually eligible for Medicare and Medicaid, will rise from 723 plans in 2022 to 809 plans available in 2023.
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Top Stars Performers Credit Careful Messaging, Provider Collaboration
As CMS resumed normal Star Ratings calculations and gave greater weight to patient experience measures for 2023, the proportion of Medicare Advantage Prescription Drug (MA-PD) plans earning 4 stars or higher saw a dramatic drop from 2022, according to newly released CMS data. In Part 2 of an AIS Health series on successful Star Ratings strategies, top performers say maintaining a company-wide focus on quality and member experience is critical to their approach. And while member outreach is a critical part of those initiatives, successful plans are careful to avoid overcommunicating with members and creating message fatigue, sources tell AIS Health, a division of MMIT.
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Growing Number of Seniors Have Access to ‘Expanded Primarily Health-Related Benefits’
More than 1,400 Medicare Advantage plans will offer at least one Expanded Primarily Health-Related Benefit (EPHRB) in the 2023 plan year, according to a new report from ATI Advisory. CMS in 2019 reinterpreted the definition of what constitutes as a “primary health-related” benefit, which allowed plans to offer a wider range of supplemental benefits such as adult day health services, support for caregivers of enrollees and therapeutic massage. The most commonly offered EPHRB is in-home support services, which is available in at least one plan in the majority of U.S. counties, according to ATI’s analysis. Two EPHRBs — in-home support services and support for caregivers — saw significant uptake from 2022 to 2023, growing 50% and 83%, respectively. An earlier analysis from ATI found that more than 30% of MA members are currently enrolled in a plan that offers at least one type of supplemental benefit, which includes both EPHRBs and Special Supplemental Benefits for the Chronically Ill.
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News Briefs: CMS Will Release Results From 90 Audits of MA Plans' Risk Adjustment Data
Settling a lawsuit filed by Kaiser Health News, CMS has agreed to release the results of 90 Risk Adjustment Data Validation (RADV) audits of Medicare Advantage plans for payment years 2011 through 2013, KHN reported. The news outlet in September 2019 filed the suit under the Freedom of Information Act in an effort to make public “vital information” about the estimated $600 million in overpayments the government aims to collect from plans through those completed RADV audits, said KHN. Under the settlement, CMS will share audit spreadsheets showing which medical diagnoses could not be confirmed but will redact the payment amounts. The agency has already sent the first round of records, according to KHN.
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